Infarct Volume is a Major Determiner of Post-Stroke Immune Cell Function and Susceptibility to Infection
Infarct Volume is a Major Determiner of Post-Stroke Immune Cell Function and Susceptibility to Infection
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DOI：
10.1161/strokeaha.109.557967
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发表时间：
2009-10-01
期刊：
影响因子：
8.3
通讯作者：
Veltkamp, Roland
中科院分区：
文献类型：
--
作者：
Hug, Andreas;Dalpke, Alexander;Veltkamp, Roland
背景和目的-人类急性缺血性卒中与免疫系统的深刻改变有关。这种中风引起的免疫抑制综合征的特征是：淋巴细胞减少，T辅助细胞和单核细胞功能受损。我们研究了中风的具体因素预测这些免疫学的改变和随后的infecties. Methods白细胞/淋巴细胞亚群进行了评估系列白色血细胞计数和荧光激活细胞分选仪分析缺血性中风患者（n = 50）在基线，第1天，第4天中风发作后，并与年龄匹配的对照组（n = 40）。同时，单核细胞人类白细胞抗原-DR的表达和血液单核细胞的体外功能进行了评估，通过产生肿瘤坏死因子-α刺激后与脂多糖。研究这些免疫学参数与卒中特异性因素（国立卫生研究院卒中量表，梗死面积）的关系。多因素logistic回归分析用于识别脑卒中后呼吸道和泌尿道感染的早期预测因子。结果脑出血体积是脑卒中后第1天和第4天淋巴细胞减少的主要相关因素。特别是，中风后血液自然杀伤细胞计数减少。缺血后单核细胞计数增加，主要是在广泛梗死后显著失活。在单变量分析中，辅助性T细胞计数减少、单核细胞人类白细胞抗原-DR表达和单核细胞肿瘤坏死因子-α的体外产生与感染相关。然而，只有每搏输出量作为呼吸道感染的独立早期预测因子（OR 1.03; CI 1.01 - 1.04）。结论：血容量决定了淋巴细胞减少、单核细胞功能障碍的程度，是随后感染的主要预测因子。（中风。2009;40：3226-3232）。
Background and Purpose-Acute ischemic stroke in humans is associated with profound alterations in the immune system. Hallmarks of this stroke-induced immunodepression syndrome are: lymphocytopenia, impairment of T helper cell and monocyte function. We studied which stroke-specific factors predict these immunologic alterations and subsequent infections.Methods-Leukocyte/lymphocyte subsets were assessed serially by white blood cell count and fluorescence-activated cell sorter analysis in ischemic stroke patients (n = 50) at baseline, day 1, and day 4 after stroke onset and compared to an age-matched control group (n = 40). Concomitantly, monocytic human leukocyte antigen-DR expression and the in vitro function of blood monocytes measured by the production of tumor necrosis factor-alpha upon stimulation with lipopolysaccharide were assessed. Associations of these immunologic parameters with stroke specific factors (National Institutes of Health Stroke Scale, infarct size) were explored. Multivariable logistic regression analysis was applied to identify early predictors for poststroke respiratory and urinary tract infections.Results-Infarct volume was the main factor associated with lymphocytopenia on day 1 and day 4 poststroke. Particularly, blood natural killer cell counts were reduced after stroke. Monocyte counts increased after ischemia paralleled by a profound deactivation predominantly after extensive infarcts. Reduced T helper cell counts, monocytic human leukocyte antigen-DR expression, and monocytic in vitro production of tumor necrosis factor-alpha were associated with infections in univariate analyses. However, only stroke volume prevailed as independent early predictor for respiratory infections (OR 1.03; CI 1.01 to 1.04).Conclusions-Infarct volume determines the extent of lymphocytopenia, monocyte dysfunction, and is a main predictor for subsequent infections. (Stroke. 2009;40:3226-3232.)